PURPOSE Gastric atrophy is a premalignant condition. The aim of this study was to evaluate the correlation between histological and endoscopic findings of atrophy, and to analyze the affecting factors.

METHODS Atrophy was graded by endoscopy, and biopsy was performed in the antrum and body for the diagnosis of atrophy according to the Sydney system in the 1,330 subjects.

RESULTS Both endoscopic and histological atrophy increased in proportion to age (P < 0.001). The prevalence of endoscopic atrophy was significantly lower than that of histological atrophy especially below 50 years of age. The sensitivity and specificity of endoscopy for the diagnosis of atrophy based on histological diagnosis of atrophy were 61.5 and 57.7% in the antrum, and were 46.8 and 76.4% in the body of the stomach. Multivariate analysis showed that an age <50 (OR 0.38, 95% CI 0.25-0.61) and a PG I/II ratio >3 (OR 0.50, 95% CI 0.35-0.71) in the antrum, and an age < 50 (OR 0.43, 95% CI 0.19-1.00) and a CRP > 5 mg/dl (OR 0.53, 95% CI 0.30-0.94) decreased the sensitivity of the endoscopic diagnosis of atrophy in the body.

CONCLUSIONS A high index of suspicion of gastric atrophy is important in the young age group, and confirmation of the diagnosis by histology is necessary.